1. What are some surgical options for osteoarthritis?
2. What are some contraindications
1. total joint arthroplasty (TJA) or TOTAL JOINT REPLACEMENT.
2. infxn, advanced osteoporosis (may cause bone shattering), & severe inflammation (post-op may increase & cause prosthetic failure)
Knee replacement last about 10-15 years.. so you might want to wait til later years to get this
1. What is a potential compliation for total hip arthroplasty?
2. What drug(s) are usually used to prevent this complication
1. Potential for infection
2. Prophylactic IV abx pre-op
What is the most commonly replaced joint surgery?
THA - Total Hip arthroplasty
Give some nursing interventions for each of the following post-op complications of THA.
1) subluxation (partial) or total dislocation
2) venous thromboembolism
5) neurovascular compromise
1)keep legs abducted, prevent hip flexion beyond 90 degrees. (Signs of dislocation - pain, rotation, extremity shortening), use raised toilet seats, straight back chairs, reclining W/C
2)Thigh high TEDs, SCDs, foot pumps; anticoagulants, exercise & OOB POD #1
3) most likely from contamination during surgery (older adults may not have a fever but altered mental status) - watch for s&s of infxn
4) monitor dressing & drains, & H/H
5) compares operative & non operative leg
What is one huge NURSING INTERVENTION for pt. after HIP replacement surgery?
LEGS can never cross median!
Keep legs abductive - use pillows
Don't want them to bend down & tie their shoes
Sitting up straight or reclined is OK.
Don't want to decrease 90 degree angle by by bending over.
What are some important NURSING INTERVENTIONS after a knee replacement surgery?
5. LIFE THREATENING: BONE MARROW SUPPRESSION (anemia & thrombocytopenia) : reduce risk of infections, stimulate bone marrow production of immune system cells, biologic response modifiers (neucogen, ecogen shots)
1. What are the usual causes of DIC (Disseminated Intravascular Coagulation)?
2. What is DIC?
1. Sepsis. Triggered by cancer
2. Release of thrombin or thromboplastin from cancer cells, abnormal extensive clotting occurs thru out the small blood vessels, using up all clotting factors & platelets --> bleeding
1.How do you prevent sepsis?
2.How do you prevent DIC?
1. HYGIENE! ABX! i.e: simple UTI can cause sepsis
2. Prevent sepsis, prevent DIC
1. Explain how cancer causes SIADH?
2. What is the rx for SIADH?
1. Some tumors can stimulate the brain to make & secrete ADH, water is reabsorbed to excess by the kidney & put into systemic circulation leading to HYPONATREMIA
2. RX: restrict water & increase Na
1. Secondary (palliative) bone cancers usually are...
2. What are bone seeking cancers?
1. metastatic cancers d/t previous xrt!
2. Prostate, breast, kidney, thyroid, lung (PBKTL - pack Burger King to lunch)
Large #s of tumor cells are destroyed rapidly, HOWEVER, their intracellular contents (K & purines) are released into the bloodstream (hyperK & acute renal faiulre d/t uric acid build up).
Rx for this?
Tumor Lysis Syndrome
Rx: hydration to dilute K & increase GFR to get rid of uric acid
Small breasted women w augmentation -- is BSE be easily performed?
YES! b/c it prosthesis is behind breast tissue
What are the barriers for mammography?
2. Fear of XRT
3. Fear of results - benign breast tissues don't make you a higher risk.
4. Concern about pain
5. Knowledge - family hx - only 5% of breast cancers are hereditary
Simple mastectomy are breast tissue & nipple
Modified radical removes affected lymph nodes. Can you take BP on that arm?
T or F
Radiation damage to normal tissue starts the inflammatory process that causes tissue fibrosis & scarring (i.e: uterine radiation may affect the colon years later)
What are the S&S of anemia? (10)
2. Weakness, fatigue, dizziness, pallor
3. GI symptoms
5. Red, sore tongue
What are the complications of anemia?
1. Angina/HF/MI (not enough O2 & blood to heart)
4. Injuries (feel dizzy & fall)
Based on the complications of anemia: heart dz, paresthesias, confusion, injuries... what are the interventions for anemia?
1. Manage fatigue
2. Maintain optimal tissue perfusion
3. Encourage adequate nutrition
4. Monitor for potential complications
How do you confirm aplastic anemia ?
Bone marrow aspiration
What induce RBC sickling? (7)
What are some complications of sickle cell anemia? & what are the interventions?
HD CA AE I
1. They're on lifelong abx (for infxn) - pt. education
2. Open area of legs that will not heal - prevention & aggressive rx of infxn
4. Damaged spleen (RBCs undergo massive hemolysis in spleen)
5. Occlusion, PAIN -pain management, organ damage (d/t SICKLED & stiff RBCs plugging the microvasculature) - stem cell transplantation
Can death be resulted from polycythemia? If so, describe the process of how this condition can lead to death.
Poly --> too much RBCs, (sometimes WBCs, platelets)--> hypercoagulable state --> clotting, stroke (d/t unhealthy platelets)
What are the primary causes of polycythemia verA?
1. Bone marrow d.o
2. Jewish males of European descent
What are the secondary causes for polycythemia?
1. Hypoxia - COPD, renal cancer, smoking, high altitutde
2. Physiologic responses to chronic hypoxia
What are the CM for polycythemia? (8)
3. plethora - red bright cheeks
5. pruritis (liver damage?)
6. SPLENOMEGALY (b/c try to get rid of excessive RBC)
7. Thrombus formation
8. Visual distrubances
Should a polycythemic pt. takes oral supplements, or folic acid supplements?
NOOOO.... THEY ALREADY HAVE TOO MUCH RBCS!
1. What is the administration time for blood infusion?
2. After removal from blood bank, what is the time frame to administer blood?
3. When should you change blood tubing?
4. Should you leave a pt. w/ blood transfusion while blood is infusing?
1. 2 to 4 hrs
2. Within 30 min.
3. after 2 units, unless kinks or troubles in tubings.
4. NO. Initiate blood slowly for 15 min, be there to increase flow rate as tolerated
Pt. is getting blood infusion. Suddenly, she develops a fever, chills, low back pain, nausea, CHEST TIGHTNESS, & anxiety.
What are you suspecting & what should you do?
Acute hemolytic RXN.
DISCONTINUE IMMEDIATELY & infuse NS thru new tubing
What is the name of the test for leukemia?
What are 2 types of leukemia?
1. ALL: acute lymphcytic leukemia
2. Meylogenous (nonlympholytic) - poor prognosis
CHRONIC LYMPHOLYTIC & MYELOGENOUS
Leukemic pts are vulnerable to what type of conditions?
Infection & anemia (secondary to bone marrow destruction)
What happens when WBCs are not functional in leukemia?